Acute urinary retention associated with prostatic carcinoma

We describe the prospective evaluation of 90 patients seen at 2 medical centers who presented with acute urinary retention. All patients had a pre-retention history obtained, as well as careful prostate examination, perineal prostate biopsy and followup treatment or monitoring. Prostate cancer was found in 12 of the 90 patients (13.3 per cent), while 1 had metastatic leukemia to the prostate. Of the 90 patients 69 (76.7 per cent) had a palpably benign prostate and 2 malignancies (2.9 per cent) were diagnosed, while 11 malignancies occurred in 21 patients (52.4 per cent) with a suspicious examination. A total of 46 patients (51.1 per cent) underwent further prostate resection and no malignancy was found in any of these specimens: 43 underwent transurethral resection (24.9 gm. average), while 3 underwent open prostatectomy (97 gm. average). Other etiologies of acute retention included benign hyperplasia, other underlying illness, medical procedures, medications, prostatitis and prostatic infarction. Among the 44 patients who did not undergo prostatectomy 13 had treatment of the diagnosed cancer, 9 had resolution of retention and symptoms without intervention, 9 remained catheterized due to severe medical problems, 8 were treated for prostatitis, 2 had discontinuation of sympathomimetic drugs and 1 each underwent urethrotomy, bladder neck incision and resolution of prostatic infarction. In contrast to the older literature in which approximately 25 per cent of the patients presenting with acute urinary retention had prostate cancer, our data suggest a lower incidence. Prostatic biopsy for patients who present with acute urinary retention and a benign examination does not appear to be justified.